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Obstructive Sleep Apnea (OSA)

Waking up after night of poor sleep

Obstructive sleep apnea (OSA) is the most common form of sleep apnea, with around 25 million sufferers in the U.S. It is characterized by frequent pauses in breathing while asleep.Obstructive sleep apnea occurs when the muscles in the back of the throat relax, blocking the airway. These muscles help to support oral and pharyngeal structures like the tongue, uvula, soft palate, and tonsils.

When the airway is either completely or partially blocked, there are usually 10 to 20 seconds of breathing cessation, which can lower blood oxygen levels. The brain panics when this happens and rouses the body to restart breathing. Generally, this is a very brief awakening that most people do not notice or remember. It can happen over 30 times an hour, all throughout the night, which significantly disrupts restful sleep cycles.

Obstructive Sleep Apnea Symptoms

The most obvious and common sign sleep apnea is loud snoring, however not everyone who snores has sleep apnea. People who have sleep apnea often experience extremely loud snoring which is followed by long periods of deafening silence when breathing stops.

Other signs and symptoms that may occur during the day or overnight include:

  • Excessive sleepiness during the day, leading to difficulty focusing and concentrating
  • Waking up in the middle of the night short of breath
  • Breathing cessation throughout the night, which is usually observed by someone else
  • Dry mouth and sore throat in the morning
  • Chest pain upon waking up
  • Morning headaches
  • Mood instability including frequent bouts of depression, anxiety, or excessive irritability
  • Insomnia, problems staying asleep, and/or restless sleep
  • Hypertension

Typically, adults and children will differ in symptoms. For example, the hallmark of obstructive sleep apnea in adults is excessive daytime sleepiness, to the point where the individual may fall asleep for short periods of time throughout regular daily activities.

Children with obstructive sleep apnea symptoms may suffer from significantly lower growth rates. Inattention, hyperactivity, and malnutrition are different manifestations of poor sleep quality that appear often in children. Children who experience obstructive sleep apnea often burn off more calories as they sleep because their bodies have to work harder to burn off calories. Due to excessive nasal and airway obstruction, children may also find it difficult to swallow food and drink. Pay close attention to any obstructive sleep apnea symptoms in children and bring any concerns to your primary care physician. 

Obstructive sleep apnea symptoms can be present for years without the person knowing they have the disorder. Many people will experience issues for only a short period of time, with symptoms disappearing after weight loss, surgery, or other lifestyle changes. Symptoms may also be the result of a respiratory infection, congestion, throat swelling, etc.

Blocked airway due to structural deformities

Obstructive Sleep Apnea Causes 

In children, enlarged tonsils or adenoids  are a common cause of obstructive sleep apnea.  Surgical removal often leads to resolution of obstructive sleep apnea symptoms.  For adults, causes may obstructive sleep apnea causes vary but include:

  • Age
  • Obesity, which may cause increased soft tissue around the airway
  • Structural deformities that obstruct the airways
  • Decrease in muscle tone, which can be caused by alcohol, substance abuse, neurological disorders, or some other underlying health conditions

Women are typically less likely to suffer from obstructive sleep apnea than men, because middle-aged men are more likely to have changing anatomy in their neck and soft tissues. Women could also be at a decreased risk because of the higher levels of progesterone, however they are more likely to suffer from obstructive sleep apnea symptoms during pregnancy and after menopause.

Furthermore, there seems to be a genetic component to obstructive sleep apnea. Studies have shown that sufferers often have a positive family history. Lifestyle factors like drinking, smoking, and overeating can increase the chances of developing obstructive sleep apnea.

Polysomnography or in-laboratory sleep study

Obstructive Sleep Apnea Diagnosis

Obstructive sleep apnea diagnosis can be determined through a series of exams and tests. Tests used for obstructive sleep apnea diagnosis are polysomnography and home sleep study sleep apnea tests.

 A primary care physician will perform a  physical exam which includes examining the back of the throat for any abnormalities, checking blood pressure, and measuring neck and waistlines. They will also try to get a holistic view of the patient’s lifestyle by asking questions about how daily activities are performed and about family history.

Polysomnography

Some doctors may recommend polysomnography, or in-laboratory sleep study, to be monitored overnight by a specialist in a sleep center who will record oxygen levels and frequency of breathing cessation or awakenings. When breathing stops, there are fluctuations in blood oxygen levels, with a subsequent increase in carbon dioxide.

In central sleep apnea, the brain sends signals to stop breathing entirely; however, in obstructive sleep apnea, the chest will continue to move up and down to simulate inhalation/exhalation without actually breathing. The monitors placed during the polysomnogram show chest movements are pronounced and often exaggerated in patients who experience obstructive sleep apnea

  1. Two frequent outcomes of polysomnography include:Apnea, which is when airflow is completely blocked and breathing stops for at least 10 seconds
  2. Hypopnea, which is when airflow is 50% decreased for at least 10 seconds, or there is a 30% decrease in airflow with a subsequent awakening or serious drop in oxygen saturation levels.

Home Sleep Test

Many sleep doctors are starting to use home sleep studies, which are much more convenient and comfortable for the patient. This is a noninvasive way of monitoring blood oxygen saturation levels during sleep.

Patients who are at higher risk of obstructive sleep apnea are first given the STOP BANG questionnaire or other sleep apnea screening questionnaires, and a significant score means they likely have obstructive sleep apnea rather than another sleep disorder. Learn more about the various home sleep test units that are used for obstructive sleep apnea diagnosis.

Obstructive Sleep Apnea Treatments

The first line of treatment for obstructive sleep apnea is a change in lifestyle changes. Reducing alcohol intake, losing weight, quitting smoking, and avoiding sedative medications are all starting points for treating sleep apnea . However, lifestyle modifications do not always resolve the issues; therefore, one or more of the below options are considered in treatment plans.

CPAP

Next to lifestyle changes, continuous positive airway pressure (CPAP) is the frontline of obstructive sleep apnea treatment. It is most effective for moderate to severe obstructive sleep apnea symptoms. These devices resemble, but are different from  ventilators. A facemask is attached to a tube, which is connected to a machine that continuously pushes positive airway pressure into the breathing passages. This helps to keep the airways open to facilitate easier breathing.

VPAP

Variable positive airway pressure, also known as BiPAP, is another type of ventilation, but instead of continuous airway pressure, the machine uses a circuit to monitor breathing and provides two different pressures: one for inhalation and one for exhalation. The inhalation pressure is higher than the exhalation pressure. This obstructive sleep apnea treatment is more common in patients with serious respiratory conditions.

Nasal EPAP

This bandage-type device is placed over the nostrils to enhance the person’s regular breathing cycles, create positive airway pressure, and prevent obstruction. This is a device commonly used in mild cases of obstructive sleep apnea.

Sleep Apnea Oral Appliances

Splints or other oral appliances are sometimes used in conjunction with other obstructive sleep apnea treatments. Patients often prefer them because they are less “invasive” than CPAP, but sometimes they do not work as well. These splints are mouth guards that keep the passages open and protect the teeth and gums. It holds the lower jaw down and forward to keep it in a more forward position, while simultaneously holding the tongue further away from the airway.

Sleep Apnea Surgery

Sometimes, modifying airway anatomy is necessary to treat obstructive sleep apnea symptoms.  These types of surgeries will vary depending on the cause of the condition and the patient’s anatomy.  The various operative procedures include:

  • Tonsillectomy and adenoidectomy
  • Nasal surgery such as turbinectomy or straightening a deviated septum
  • Reduction or removal of uvula or soft palate
  • Reduction of the size of the tongue base
  • A procedure that surgically moves the jaw forward, pulling the tongue away from the back of the throat (genioglossus advancement)
  • Hyoid suspension, where one of the neck bones is pulled forward
  • Bariatric surgery for morbidly obese patients

 Neurostimulation

This obstructive sleep apnea treatment is used for patients who cannot tolerate the CPAP machine. This system senses respirations and stimulates the hypoglossal nerve with electrical currents to increase muscle tone, which will help avoid the tongue collapsing to the back of the throat and blocking the airway.

Possible long-term effects of obstructive sleep apnea

What is the Prognosis for Patients with Obstructive Sleep Apnea

The apneic and hypopneic events associated with obstructive sleep apnea cause a fight or flight response in the body, which further creates a hormonal reaction. Excessive use of this response can put an undue amount of stress on the body, exhausting the glands and organs that are activated during the fight or flight response. This, paired with consistently low oxygen saturation levels, can lead to long-term dangerous health consequences.

If the above obstructive sleep apnea symptoms become so severe that daily activities and work are affected, then it’s time to seek medical attention. Untreated obstructive sleep apnea can lead to long-term serious conditions such as:

  • Cardiovascular disease
  • Obesity
  • Diabetes
  • Daytime fatigue, which can be hazardous in school or work environments and driving
  • Eye and vision problems
  • Mood and psychiatric disorders

One of the most serious concerns of untreated obstructive sleep apnea is cardiovascular disease. Sleep apnea patients are at 30% higher risk of heart attack and heart-related death than those without the condition.  Increased pulmonary pressures to the right side of the heart, a major concern in prolonged cases of obstructive sleep apnea, can result in cor pulmonale, a very serious and dangerous form of congestive heart failure.

Obstructive sleep apnea and very loud snoring may seem harmless at first, but they can lead to a laundry list of symptoms as well as more serious and extensive health concerns, so diagnosis and monitoring should be a priority.

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7 comments on “Obstructive Sleep Apnea (OSA)”

  1. To Tara...
    i know your replies are from 3 year ago but i felt like i needed to respond to you even though you may not see this... for starters no these people are not trying to put just anyone on sleep apnea machines. if the sleep study says that someone has sleep apena you can bet your weekly pay they have it.....another thing is your husband isnt suppose to be taking sleeping pills to sleep because of the pills making the sleep apnea worse....if a doctor put him on those your husband needs to get another doctor before that one kills him.....there are times that people doesnt even know for sure if they have sleep apnea or not untill they are tested to find out.....not everyone if you would do your research looks to be not breathing during sleep and some cases are very mild to where you dont completely quite breathing you just slow down in breathing enough to actually have sleep apnea...the snoring your husband does if it affects the cuddle factor of you and your husband then yes he has sleep apnea that is a major symptom of it...also they do not drug you when they do sleep studies in a sleep center i know ive been thorugh it....they just let u change get the testing equipment ready and attached to the patient let you lay down for the night and start their study just like you sleeping at home NO DRUGS INVOLVED and when and if you are dignoised with sleep apnea there is still NO DRUGS INVOLVED you just get your machine or get set up for whatever therapy fits the patient and if drugs are involved the patient better get another doctor before they kill them cause like i said sleeping pills or anything else that induces sleep makes the sleep apnea worse....thats why i dont take anything like that and if your husband cant tolerate the machine there is other alternatives....have you ever thought that those people may be slight deep sleepers anyway cause there has been times that i havent woke up as fast as i should have in a situation and guess what it was before i ever knew i had sleep apnea and got my machine..if anyone has died honey after getting put on a sleep apnea machine it wasnt because of the machine itself it was due to people taking sleeping pills and such when they shouldnt have or just plain naturally being a sound sleeper..do your research ok before you start bashing people in the medical field that knows what they are doing......

  2. I had a sleep study and my oxygen levels started dropping during sleep but the doctor said something else was going on with me, but it wasn't sleep apnea. Turns out, my walking oxygen levels were 70 and even lower during sleep. No machine was given to me but I have to have oxygen while I sleep. Turns out I had pneumonia and didn't know it. I still have to sleep with oxygen every night.

  3. CPAP really is the first line treatment option for patients with moderate and severe sleep apnea. Oral devices can work very well for people with mild and moderate sleep apnea.

  4. Also the cuddle Factor has been super ruined! My husband snores a little but has never stopped breathing according to me, however according to his sleep study it happened 39 times while he was there, but not ever with me in 20 Years???! Give me a break! I feel like they just want to put one of those machines on anyone that asks for a sleep study! I feel like I should ask for one next week even though I have no trouble sleeping! But I guarantee I stop breathing 30 times over the night.

  5. FYI my husband it has only just now taking a sleep study where they claim he does not breathe while he sleeps! I sleep with him for 14 years and I've never noticed this?! Come on exclamation point Are you seriously just trying to get everyone Last patient all drugged up so they can go to sleep? And what about these people's families? I have many friends who are single parents and use these machines to go to sleep every night because sleep studies have said they need them in order to sleep! However they cannot wake up in a timely manner in the case of an emergency and this scares the hell out of me anybody have any thoughts?!

  6. So, my husband has sleep apnea,per yourguidelines, and there's a fire in my house and because he has a sleep apnea machine now and now has to take sleeping pills in order to tolerate it,and I'm a hard sleeper already, which also means we're all going to die if there is any kind of emergency,right? How many of your patients have died because of Fire, gas leak ,Etc because they have not been able to wake up during these events!

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